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Westfield Animal Shelter Adoption Application
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* Indicates required question
Email
*
Your email
Name of animal, or description of type of animal you are interested in:
Your answer
Your name:
Your answer
Your address:
Your answer
Your city, state, and zip code:
Your answer
Primary Phone Number:
Your answer
Secondary Phone Number:
Your answer
Date of Birth:
MM
/
DD
/
YYYY
Driver's License Number:
Your answer
Email Address:
Your answer
Why do you want this pet? Check all that apply.
Companion
Protection
Gift
Other:
This pet will be without human companionship for about _____ hours per day for ____ days per week:
Your answer
Where will your pet be kept during the day? Check all that apply:
Indoors
Outdoors
Kennel
Crate
Basement
Garage
Other:
Where will your pet be kept during the night? Check all that apply:
Indoors
Outdoors
Kennel
Crate
Basement
Garage
Other:
How many adults live in your home?
Your answer
How many children live in your home? What are their ages?
Your answer
Is anyone in your family allergic to animals? (Describe)
Your answer
Where do you live?
Trailer
Rent
Own
Live with Parents
Other:
Clear selection
IF RENTING: Does your landlord allow pets?
Yes
No
NA
Clear selection
IF RENTING: Is a pet deposit required?
Yes
No
NA
Clear selection
IF RENTING: Will your monthly rent increase?
Yes
No
NA
Clear selection
IF RENTING: What is your landlord's name and phone number?
Your answer
Is your yard fenced? (If yes, describe height and type).
Your answer
Have you ever adopted a pet from us before?
Yes
No
Clear selection
Have you ever surrendered an animal to a shelter before? If yes, please explain.
Your answer
What will you do with your pets if you move in the future?
Your answer
IF ADOPTING A CAT: Do you plan to declaw your cat?
Yes
No
NA
Clear selection
IF ADOPTING A DOG: How do you plan to house train your dog?
Your answer
Do you understand that a dog/cat may live 15 or more years?
Yes
No
Clear selection
Would you be willing to allow a representative from the shelter to visit your home before the adoption is finalized?
Yes
No
Clear selection
It may take your new pet two or more weeks to adapt to its new home, especially if other pets are involved. Are you prepared to allow this much time?
Yes
No
Clear selection
Please fill in the following information about current and past pets (from the last ten years): Name, Type/Breed, Age, Sex, Nuetered/Spayed, Where they are kept, and If you still own them. If you do not still own them, please explain why.
Your answer
Please provide the name and phone number of the veterinarian(s) who cares/cared for the above animals.
Your answer
May we contact your veterinarian?
Yes
No
Clear selection
Pease call your veterinarian and give them permission to speak with a representative from the shelter before submitting your application. Please initial and date below to let us know you have contacted your veterinarian.
Your answer
A copy of your responses will be emailed to the address you provided.
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